Laws v. Wexford et al.

Filing 84

MEMORANDUM Opinion and Order. Signed by the Honorable Manish S. Shah on 2/28/2017. Defendants' motion for summary judgment, 64 , is granted. Enter judgment and terminate civil case. [For further detail see attached order.] Mailed notice. (psm, )

UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ILLINOIS
EASTERN DIVISION
MARSHAUN LAWS,
Plaintiff,

No. 15 CV 1671

v.
SALEH OBAISI, and WEXFORD HEALTH
SOURCES, INC.,

Judge Manish S. Shah

Defendants.
MEMORANDUM OPINION AND ORDER
Plaintiff Marshaun Laws, an inmate at Stateville Correctional Center, brings
an action under 42 U.S.C. § 1983 against defendants, Dr. Saleh Obaisi and Wexford
Health Sources, Inc., for violating his Eighth Amendment right to be free from cruel
and unusual punishment. Defendants move for summary judgment, arguing that
Laws has not shown that Dr. Obaisi or Wexford has been deliberately indifferent to
his objectively serious medical condition of chronic, progressive, and severe back
pain. Their motion is granted.
I.

Legal Standards
Summary judgment is appropriate if there is no genuine dispute as to any

material fact and the movant is entitled to judgment as a matter of law. Fed. R. Civ.
P. 56(a). A genuine dispute of material fact exists if “the evidence is such that a
reasonable jury could return a verdict for the nonmoving party.” Anderson v. Liberty
Lobby, Inc., 477 U.S. 242, 248 (1986). The party moving for summary judgment
bears the burden of proving the absence of such a dispute. See Celotex Corp. v.

Catrett, 477 U.S. 317, 323 (1986). All facts and reasonable inferences are construed
in the light most favorable to the nonmoving party. Chaib v. Geo Grp., Inc., 819
F.3d 337, 341 (7th Cir. 2016).
II.

Background
More than fifteen years ago, Laws sustained his first back injury when he fell

off his motorcycle. [78] ¶ 6.1 A few years after that incident, Laws sustained a
second back injury when he rolled his car while attempting to flee the police in a
high-speed chase. Id. Laws did not seek medical attention after either accident. Id.
Approximately one year after the high-speed chase, Laws was incarcerated. [78] ¶ 7.
A physician assistant evaluated Laws shortly after he was transferred to
Stateville Correctional Center in January 2013. [78] ¶ 11. During that evaluation,
Laws complained of a ten-year history of intermittent lower back pain. Id. The PA
examined Laws’s lumbar spine, which revealed no trauma, no deformity, and a full
range of motion. Id. Going forward, the PA’s plan was for Laws to undergo x-ray of
his lumbar spine, apply heat to the affected area, and return to the clinic in one
month for a follow-up appointment. Id. On the same day as this evaluation, Laws

Bracketed numbers refer to entries on the district court docket. The facts are based on
Laws’s response to Wexford’s LR 56.1 statement, [78], and Wexford’s response to Laws’s LR
56.1 statement, [82]. Unless otherwise noted, the facts related here are undisputed or are
considered undisputed because the responding party did not properly controvert the factual
statement. Statements of fact that are supported by the record, but that are not properly
controverted, are admitted. N.D. Ill. L.R. 56.1(b)(3)(c). Arguments and conjectures do not
controvert a statement of fact. See Cady v. Sheahan, 467 F.3d 1057, 1060 (7th Cir. 2006).
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underwent x-ray of his lumbar spine. [78] ¶ 12. A few days later, a radiologist
reviewed the x-ray and interpreted it as negative.2 [82] ¶ 5.
At the one-month follow-up appointment, Laws told the PA that he was
working out five days per week. The PA entered a plan to strengthen Laws’s core
and to return to the clinic on an as-needed basis. [78] ¶ 14. Approximately two
months later, during an evaluation for Laws’s complaint of a several-year history of
headaches, he told the PA that he experienced a few episodes of back pain per year,
but that he was not experiencing any such pain at the evaluation. [78] ¶ 16. The PA
entered a plan for Laws to take Tylenol, 500 mg, twice a day for three months,
apply heat to the affected area up to three times per day, apply an analgesic balm to
the affected area, and perform strengthening exercises. Id.
Dr. Obaisi evaluated Laws for the first time on November 5, 2013, in
response to Laws’s complaints of intermittent lower back pain. [78] ¶ 19. Dr. Obaisi
performed a physical examination of Laws’s back, which revealed that Laws could
bend to ninety degrees, a straight leg test within normal limits, deep tendon
reflexes within normal limits, and tenderness to palpation over the right paraspinal
musculature at L4-5. Id. From these assessments, Dr. Obaisi concluded that Laws

Dr. Obaisi reviewed and signed off on the radiologist’s report of Laws’s x-ray. [82] ¶ 6. His
signature was administrative in function—at this point, Dr. Obaisi had not performed his
own physical examination of Laws nor did he review the PA’s notes that led to the x-ray
order; he assumed the PA who initiated the x-ray would go over the report with the patient
(Laws). [66-5] at 65:16–66:12. When asked whether Dr. Obaisi considered ordering an MRI
after seeing Laws’s x-ray, Dr. Obaisi testified that an MRI was not needed because there
was no neurological deficit and Laws had intermittent back pain that could have been
caused by a muscle sprain. [66-5] at 64:22–65:7. Dr. Obaisi testified further that Laws’s
back pain was fairly common and that he would treat that type of pain with symptomatic
treatment only and not surgery, which poses other significant risks. [66-5] at 67:11–68:14.
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suffered from chronic, recurrent back pain and Dr. Obaisi entered a plan for Laws
to take Motrin, 600 mg twice a day, for sixty days. Id.
At the end of February 2014, Laws reported to Dr. Obaisi that his lower back
pain and right leg pain had resolved. [78] ¶ 21. Dr. Obaisi’s physical examination
revealed no acute findings; he entered a plan for Laws to follow up for care in three
months. Id. At the follow-up evaluation, Laws reported to Dr. Obaisi that he
experienced lower back pain intermittently. [78] ¶ 23. Dr. Obaisi’s objective
examination revealed no change in Laws’s condition; Laws continued to suffer from
chronic lower back pain. Id. Dr. Obaisi entered a plan for Laws to use an analgesic
balm, a back brace, and to apply ice to his back twice a day. Id. Approximately six
months later, a certified medical technician prepared a progress note to document a
letter Laws wrote complaining of sciatic pain. [78] ¶ 25.
On May 28, 2015, Dr. Obaisi entered an order for Plaintiff to undergo an MRI
of his lumbar spine. [78] ¶ 38. The impetus behind the MRI is disputed. Dr. Obaisi
recalls ordering the MRI in order to rule out “something major,” and to reassure
Laws. Id. Laws believes Dr. Obaisi only ordered the MRI due to a scheduled hearing
on his motion for an injunction compelling an MRI and an evaluation by an
orthopedic surgeon. Id. Ultimately, Laws underwent an MRI of his lumbar spine on
August 26, 2015. [78] ¶ 39. Dr. Obaisi reviewed the MRI results with Laws on
October 14, 2015 and entered a plan for Laws to undergo an ANA C-reactive protein
test to determine if Laws’s lower back pain was caused by rheumatoid arthritis or

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lupus.3 [78] ¶ 41. The MRI report “Impression” was “[m]ild degenerative disc
disease of the lower lumbar spine with an annular tear at L4-L5. No neural
compromise.” [66-42] at 3. Dr. Obaisi interpreted the report as showing that Laws
did not suffer from any disc herniations and thus, he concluded that the annular
tear was an unlikely cause of Laws’s intermittent back pain. [78] ¶ 39; [66-5] at
96:3–99:2. Laws interprets the MRI report as showing a herniated disc and he
references the portion of the report that discusses a “posterior disc protrusion.”
Under “Findings,” the MRI report stated, in relevant part, “L4-L5: There is a
posterior disc protrusion with annular tear. The neural foramen are widely patent
and while there is mild mass effect on the thecal sac, no evidence of spinal canal
stenosis is seen.” [66-42] at 2.
Approximately six months later, Dr. Obaisi examined Laws in response to his
complaints of low back pain, which radiated to his buttocks and groin, and
insufficient pain relief from Motrin. [78] ¶ 44. Dr. Obaisi’s impression was that
Laws suffered from diffuse osteoarthritis; Dr. Obaisi prescribed Indocin, 75 mg,
another non-steroidal anti-inflammatory drug used to treat pain, and Robaxin, a
muscle relaxant used to treat muscle spasms and pain. Id. Laws reported to a PA
one month later that he did not take the previously prescribed Indocin because of
the side effects listed on the label. [78] ¶ 47. The PA’s examination revealed no
acute findings in Laws’s lower extremities. Id. The PA’s progress note did not reveal
any evidence that Laws was experiencing any lower back pain at that time. Id. The

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Both tests produced negative results. [78] ¶ 41.

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PA entered a plan for Laws to discontinue taking Indocin and restart taking Motrin,
600 mg, four times a day. Id.
On April 5, 2016, an orthopedic surgeon from the University of Illinois
evaluated Laws.4 [78] ¶ 52. Laws explained his longstanding history of lower back
pain, but reported that overall, he was doing “okay” and had a general pain score of
zero. Id. After eliciting a history, performing a physical exam, and reviewing the
MRI, the orthopedic surgeon concluded that Laws had a disc protrusion at L4-5 and
L5-S1, mild degenerative disc disease of the lumbar spine, an annular tear at L4-5,
and no neural compromise. Id. The orthopedic surgeon’s plan was to start Laws on a
course of physical therapy and to continue using the same course of non-steroidal
anti-inflammatory medications, or to try a course of stronger medications. Id. In
response to the orthopedic surgeon’s recommendation, an order was entered at
Stateville for Laws to undergo physical therapy. [78] ¶ 53.
Since 2013, Laws has been evaluated more than twenty-five times in the
Stateville Health Care Unit for various medical conditions. [78] ¶ 61. He has
received many forms of treatment for his lower back pain including medications, an
analgesic balm, a back brace, ice, core strengthening exercises, imaging studies,
labs to test for rheumatoid factors, a permit for a low bunk, a consultation from an
orthopedic surgeon, and an order for physical therapy. [78] ¶ 62. Nothing in Laws’s
medical records from January 2013 to January 2016 show that he had difficulty

Dr. Obaisi participated in a collegial review several months before and obtained approval
for Laws to be evaluated by an offsite orthopedic surgeon in response to the MRI results.
[78] ¶ 43.
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ambulating, limited range of motion, or decreased strength in his lumbar spine or
lower extremities. [78] ¶¶ 58–59. No physician has rendered the opinion that Laws
is an appropriate candidate for invasive treatment for his lower back pain, nor has
any physician ever recommended that surgery or injection be performed on Laws’s
spine to treat his complaints. [78] ¶ 54.
III.

Analysis
A.

Dr. Obaisi

A prison official is deliberately indifferent to a prisoner’s right to medical care
and violates the prisoner’s Eighth Amendment right to be free from cruel and
unusual punishment when the prisoner suffers from an objectively serious medical
condition and the prison official is aware of the condition, but recklessly disregards
it. Conley v. Birch, 796 F.3d 742, 747 (7th Cir. 2015). Defendants do not dispute that
Laws’s lower back pain was an objectively serious medical condition of which they
were aware. Laws bases his deliberate indifference claim against Dr. Obaisi on the
insufficiency of treatment and the delay of treatment.
“A jury can infer deliberate indifference on the basis of a physician’s
treatment decision [when] the decision [is] so far afield of accepted professional
standards as to raise the inference that it was not actually based on a medical
judgment.” Arnett v. Webster, 658 F.3d 742, 751 (7th Cir. 2011) (citation omitted). It
is not enough that the prisoner wanted more or different treatment than the
physician prescribed. Edwards v. Snyder, 478 F.3d 827, 831 (7th Cir. 2007) (citing
Estelle v. Gamble, 429 U.S. 97, 107 (1976)). The physician’s decision must be one

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that no other minimally competent professional would have reached under similar
circumstances. Id. Laws has not cleared this hurdle.
Laws believes his lower back pain is consistent with a sciatica caused by a
herniated disc. Laws says Dr. Obaisi should not have ordered an x-ray of his lumbar
spine in 2013 because “[i]t is well recognized in the medical literature […] that xrays will not show evidence of a herniated disc.” [76] at 1. He cites three articles for
this proposition, two of which are not relevant.5 The Mayo Clinic’s article “Sciatica”
is relevant, but it does not support Laws’s factual assertion. Instead, the Mayo
Clinic article explains: “Many people have herniated disks or bone spurs that will
show up on X-rays and other imaging tests but cause no symptoms. So doctors don’t
typically order these types of tests unless your pain is very severe or it doesn't
improve within a few weeks.” [77-16] at 4. With respect to an x-ray, the Mayo Clinic
article also states: “An X-ray of your spine may reveal an overgrowth of bone (bone
spur) that may be pressing on a nerve.” Id. Laws says if Dr. Obaisi had ordered an
MRI in 2013, he would have received a proper diagnosis and in turn, proper

The first is a 2007 article from The New England Journal of Medicine titled “Surgery
versus Prolonged Conservative Treatment for Sciatica” that studied 283 patients who had
had sciatica for six to twelve weeks and concluded that the outcomes after one year were
similar for patients who had undergone early surgery as compared to those who received
conservative treatment with eventual surgery if needed, but the rates of pain relief and
perceived recovery were faster for the former group. [77-15] at 1. The second is an abstract
of a 1992 Spine article titled “The Natural History of Sciatica Associated with Disc
Pathology: A Prospective Study with Clinical and Independent Radiologic Follow-Up” that
studied 165 patients with an average duration of sciatica symptoms of 4.2 months and
reached a similar conclusion—all conservatively managed patients made a satisfactory
clinical recovery and only a small proportion of patients needed surgical decompression.
[77-17] at 1.
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treatment.6 To support his point, Laws relies on his interpretation of the MRI
results as showing a herniated disc and the recommendation by the orthopedic
surgeon for Laws to undergo physical therapy.
The medical literature Laws offers does not support his deliberate
indifference claim; if anything, the Mayo Clinic article shows that Dr. Obaisi’s
decision to order an x-ray was consistent with professional standards of treating
sciatica (or lower back) pain. The record also does not support Laws’s deliberate
indifference claim; instead, it shows that Laws’s lower back pain did not worsen and
was manageable under Dr. Obaisi’s pre-MRI treatment plan and that Laws
experienced some periods of no lower back pain whatsoever. In total, Wexford’s
medical team evaluated Laws more than twenty-five times for various medical
conditions, including his lower back pain and continuously adjusted his treatment
plan to respond to his ailments. Consequently, Laws’s deliberate indifference claim
fails insofar as it is based on a theory of insufficient treatment.
In the context of delayed treatment, courts require “‘verifying medical
evidence’ that the delay (rather than the inmate’s underlying condition) caused
some degree of harm.” Williams v. Liefer, 491 F.3d 710, 714–15 (7th Cir. 2007)
(citations omitted). Laws does not present any “verifying medical evidence.” Instead,
he argues that the consistency of his symptoms since 2013 shows that he would
have been given the same treatment regimen then that he is currently participating
in now. He concludes that Dr. Obaisi’s inaction delayed his “inevitable and

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As noted above, the parties dispute whether the MRI results showed a herniated disc.

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necessary treatment.” [76] at 4. Presumably, Laws is referring to the physical
therapy order, as that is the only change to his treatment plan that followed the
MRI and consultation. No further details exist in the record, however, about how
the physical therapy treatment plan would be similar to or different from the preexisting treatment plan for Laws to strengthen his core. Since Laws has not
presented any evidence about an effect the delayed MRI or consultation (or resulting
physical therapy) had, his claim cannot advance. Dr. Obaisi is entitled to judgment
as a matter of law on Laws’s deliberate indifference claim.
B.

Wexford

A private corporation, like Wexford, is liable for deliberate indifference if it
maintains an unconstitutional policy or custom that was the moving force behind
the prisoner’s injuries. Shields v. Ill. Dep’t of Corr., 746 F.3d 782, 789 (7th Cir.
2014); Pyles v. Fahim, 771 F.3d 403, 409–10 (7th Cir. 2014). There are no brightline rules defining a widespread custom, Thomas v. Cook Cnty. Sheriff's Dep’t, 604
F.3d 293, 303 (7th Cir. 2010), but a pattern of bad acts is a reasonable basis from
which a jury could infer that the corporation was aware of the constitutional
violations and did nothing in response. Hahn v. Walsh, 762 F.3d 617, 637 (7th Cir.
2014). On the other hand, evidence of one individual’s experience is typically not
enough to confer liability on a corporation—a custom cannot be established by proof
of a random event. Grieveson v. Anderson, 538 F.3d 763, 774 (7th Cir. 2008)
(citations omitted). Assuming Laws could prove he was injured, his deliberate
indifference claim against Wexford still fails because he has no evidence to support

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a causal link between Dr. Obaisi’s decision to not order an MRI and consultation
with a specialist after first evaluating Laws and a Wexford policy or custom.
Laws argues that Wexford’s “Medical Policies and Procedures Guidelines
Protocols” is evidence of a policy to discourage offsite consultations for patients with
lower back pain. See [66-55]. He notes that the primary prescription for chronic
back pain according to the manual is heat, NSAIDs, muscle relaxant, and range of
motion exercises. See [66-55] at 6. Further, he takes issue with the fact that
“sophisticated diagnostic work up and treatment,” [76] at 2, is left to the clinician’s
discretion under the manual, see id. Laws says the manual’s reference to the
clinician’s discretion is a pretext to deny further treatment beyond Stateville’s
Health Care Unit. He cites Wexford’s contract with the state of Illinois through the
Illinois Department of Healthcare and Family Services and the Illinois Department
of Corrections as evidence that Wexford has a financial incentive to limit the
number of offsite referrals.7 See [77-11]. Specifically, Laws relies on a provision in
the contract about referrals to the University of Illinois, which states: “The number
of referrals per contractual year from all of the specified Centers to the UIMCC
shall not exceed 216 inpatient admissions and 2,180 outpatient visits per year
unless approved in advance […]. Compensation adjustment, in accordance with

A common criticism of Wexford is that it withholds medical care as a cost-savings
measure. See Lamonte Lake v. Wexford Health Sources, Inc., No. 15-2360, slip op. at 2 (7th
Cir. Feb. 15, 2017) (citing Michael Sandler, Illinois Prison Contractor Paid $3.1 Million to
Resolve Complaints Over Five Years, MODERN HEALTHCARE (May 20, 2015),
http://www.modernhealthcare.com/article/20150520/NEWS/150529989; Jason Meisner,
Independent Experts Blast Quality of Medical Care in Illinois Prisons, CHICAGO TRIBUNE
(May
19,
2015),
www.chicagotribune.com/news/ct-illinois-prison-medical-care-met20150519-story.html.
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Section 3, will be taken if [Wexford] over utilizes stays/visits during a year.” [77-11]
at 8.
There is nothing in the record tying Dr. Obaisi’s decision-making to a concern
about the number of offsite referrals per year or to Wexford’s financial incentives
generally. In fact, Dr. Obaisi testified that he was not familiar with Wexford’s
contract with the state of Illinois, nor had he reviewed its terms to determine
whether or not the operations at Stateville were compliant. [66-5] at 5:14–6:1. There
also is no evidence that any other members of Wexford’s medical team consider
Wexford’s policy and or contract when creating treatment plans for Stateville
prisoners, especially plans that would otherwise include offsite treatments. From
the undisputed record, therefore, a jury would infer that the moving force behind
Dr. Obaisi’s decisions were his own medical judgment and not any Wexford policy or
custom. Without the necessary evidence to connect Dr. Obaisi’s decision-making to
an unconstitutional Wexford policy or custom, Laws’s deliberate indifference claim
fails. Wexford is entitled to summary judgment on this claim.
IV.

Conclusion
Defendants’ motion for summary judgment, [64], is granted. Enter judgment

and terminate civil case.

ENTER:
___________________________
Manish S. Shah
United States District Judge

Date: 2/28/2017
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